Mental Health Bill [HL]

Baroness Merron Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

Moved by

[Baroness Merron]

That the Bill be now read a second time.

Relevant document: Report of the Joint Committee on the Draft Mental Health Bill, Session 2022-23. Welsh legislative consent sought.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, it is an honour to move the Second Reading of the Mental Health Bill—a Bill which Members of both Houses have been waiting for and working on for some considerable time.

There is much consensus that our mental health laws are not fit for the 21st century. Many elements of the Mental Health Act 1983 are outdated. Its operation is associated with racial disparities and poor care for people with a learning disability and autistic people, and it fails to give patients an adequate voice. Modernising the Mental Health Act is a vital manifesto commitment for this Government, so I am proud to introduce reforms that will ensure that care is appropriate, compassionate and effective; give patients more say over their care; improve support to help patients understand and exercise their rights; and protect the safety of the public, staff and patients.

The wait has been too long. I know that a number of noble Lords were involved when the Act was last amended substantially in 2007, but, although attitudes to mental health have, thankfully, changed since then, the law has not kept up. The Bill is the product of the combined effort over some years by Members of both Houses and many outside Parliament, and all parties have rightly come together to support it. Sincere thanks are due to many, but I will highlight just a few, starting with Members of your Lordships’ House who served on the pre-legislative scrutiny committee in 2022: the noble Baroness, Lady Buscombe, as chair, as well as the noble Baronesses, Lady Barker, Lady Berridge, Lady Hollins and Lady McIntosh of Hudnall, and the noble Lord, Lord Bradley. All have given a huge amount of time, expertise and energy, which has informed and motivated this Government to strengthen the Bill. I confirm that we have improved the previous draft Bill by heeding the committee’s recommendations to include guiding principles and advance choice documents in this revised Bill.

I pay tribute to the former Prime Minister, the noble Baroness, Lady May, whom I had the pleasure of meeting earlier today with the Secretary of State. The noble Baroness, Lady May, identified the need for modernisation and set up the independent review of the Act in 2017. Without this, we would not be here today. I thank the independent review chair, Sir Simon Wessely, and his vice-chairs, including the noble Baroness, Lady Neuberger, who made the case for change and provided the blueprint to follow. I know they will continue to be champions for reform. I also thank the many stakeholders and parliamentarians who have engaged with us ahead of Second Reading and over the years, and those with lived experience, who have bravely told their stories.

The Bill will complement other major reforms that this Government have announced. The Budget announced £26 million to be invested in new mental health crisis centres to reduce pressure on accident and emergency departments. To cut mental health waiting lists, we will go further still, recruiting an additional 8,500 staff. As part of our mission to reduce the number of lives lost to suicide, these NHS workers will be specially trained to support people at risk. We will improve support for young people, with walk-in hubs in every community, making support workers more accessible to children, and a specialist mental health professional based in every school. The NHS has asked every provider of mental health services to review its offer for serious mental illness. By focusing on early intervention—prevention is the key—we seek to prevent people reaching crisis and to reduce the need for detentions in the first place.

I turn to what the Bill seeks to achieve. The Mental Health Act is there to protect people. Its core purpose is, and will remain, to be able to intervene, detain and treat when someone is so unwell that they present a risk to themselves or others. The overall aims of these reforms are to improve the care and treatment of people with severe mental illnesses when detained under the Act, to improve patient outcomes and recovery, and to protect the public, patients and staff. The existing Act confers certain rights on people who are detained, including the right to appeal their detention at a tribunal and a right to an advocate as well as to a medical second opinion in certain circumstances. The Bill seeks to strengthen and expand these rights. It will require the inclusion in the statutory code of practice of the new and revised guiding principles recommended by the independent review, which in turn informs professional practice around the Act. By doing this, we aim to improve things for patients and support a change in culture.

We are strengthening and clarifying the detention criteria to make clear that people will be detained only if they pose a risk of serious harm to themselves and/or others, and if there is a reasonable prospect that they will benefit from the proposed treatment. We are reforming the use of community treatment orders—CTOs—to reflect the revised criteria, to increase oversight and scrutiny of decision-making, and to improve the transfer of patients under a CTO from hospital to community services. We are also introducing statutory care and treatment plans for patients detained under the Act, except when under very short-term sections, to provide a clear plan for a patient’s recovery and a path to discharge.

Where the patient’s voice has previously been unheard, the Bill will place them at the centre of their care and treatment. We are introducing a new clinical checklist requiring clinicians to, as far as possible, involve patients in decisions about their care and to take their feelings and wishes into account.

We are making sure that patients know they can create an advance choice document and that appropriate support is available to help them do so, allowing those at risk of detention under the Act to outline their wishes and decisions while they are well. This document helps them retain control over decisions about their admission, care and treatment if they later become too unwell to communicate these preferences. Last week I saw and heard about the differences that these can make on my visit to the South London and Maudsley, where the words of welcome from service users about these measures highlighted the contribution that advance choice documents can make, particularly to tackle racial inequalities.

We are allowing patients to choose a nominated person to look out for them and their interests when detained and will be increasing their powers. The independent mental health advocacy service was a notable success of the 2007 reforms to the Act. It is a thriving sector, with advocates and volunteers working for excellent organisations such as VoiceAbility, making sure that people are involved with decisions about their care.

We are now looking to expand these services in two ways. First, we are making sure that patients who come into hospital voluntarily can access an advocate to help them understand their rights and be involved in decisions about their care. Secondly, for detained patients, access to advocacy will be on an opt-out basis, ensuring that patients are proactively offered this support when detained to improve advocacy uptake among detained patients.

I know only too well that noble Lords are acutely aware that for some people with a learning disability and autistic people, detention is both non-therapeutic and unnecessarily long. In order to better meet people’s needs in the community, we will limit detention so that people with a learning disability and autistic people can no longer be detained beyond 28 days, unless they have a co-occurring mental health condition that requires hospital treatment. This will affect only civil patients. Hospital will remain an option for those in contact with the criminal justice system, where the only alternative to detention in hospital is prison.

For people with a learning disability and autistic people, the right measures and support are very much needed alongside this change. That is why the Act will require that when people are detained, there is a care (education) and treatment review to be given due weight in decision-making. We are also creating new duties on commissioners to hold registers to help manage the risk of people going into crisis and being detained, and to better meet the needs of people through appropriate community services.

I am grateful for the work of the Ministry of Justice Minister, my noble friend Lord Timpson, and his department, to improve access to mental health care and treatment for people in the criminal justice system. The Bill will end the use of both prison and police cells as places of safety. It will end the use of remand for own protection under the Bail Act where the court’s sole concern is the defendant’s mental health.

We will introduce a statutory 28-day time limit for transfers from prison and other places of detention to hospital when a person requires treatment for their mental health under the Act. We will also introduce a subset of conditional discharge, called supervised discharge, to support the small number of restricted patients who are no longer benefiting from being in hospital.

We are aware that there have been concerns about public safety and are therefore ensuring that our reforms do not weaken the ability to detain people who could pose a risk of serious harm to themselves or others. I assure your Lordships’ House that these reforms do not change the core function of the Mental Health Act. Clinicians will remain able to intervene, to detain, and to treat whenever someone with severe mental illness presents a risk to themselves or others.

We are confident that this is the right package of reforms. However, the Bill further strengthens the measures in respect of public protection. The Bill improves on the previous draft Bill by: first, accepting the Joint Committee’s recommendation to remove “how soon” from the new detention criteria, making sure the Act cannot be misinterpreted to mean that a harm must be imminent to justify detention and early intervention; secondly, introducing a new requirement for the responsible clinician to consult another person when they are making a decision about whether to discharge a patient; and thirdly, strengthening the code of practice’s guidance on discharging patients and promoting the need for discharge planning tailored to the individual needs of patients and their circumstances. We will consult on changes to the code.

I am very grateful to noble Lords across the House for their ongoing support for and interest in the Bill. It has been a long time coming, and I know that we all want to get this on the statute book, which is why it is a priority piece of legislation for this Government. There has been a failure to reform, but today we begin to change that. I look forward to what I know will be a collegiate and constructive debate, which many will follow—inside both Houses and outside. I beg to move.

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[Baroness Merron (Lab)]

My Lords, I put on record my gratitude to all Members of your Lordships’ House for contributing to what was widely agreed, I am sure, to have been an excellent debate—excellent not just because of the level of engagement but because of the detail. I really feel that spirit of wanting to improve the legislation and the support for the Bill thus far. I will endeavour to respond to as many themes as possible; I am very grateful to the noble Lord, Lord Kamall, for his sympathy, which I accept, but I regard that as a good thing. I regard it as admirable that I will not be able to answer all the questions, because that is the purpose of being here. It sets us up for Committee. It is obviously going to be a very rich Committee, and I very much look forward to it.

I hope noble Lords will understand that I look forward to following up on the many points that I will not get a chance to address in the time I have and doing a proper review of the debate today, picking up points as needed. I pay tribute to the dedication and the detailed attention to the Bill that noble Lords have already given. I am very glad to see my right honourable friend the Secretary of State gazing on. The reason I say that now is that the Secretary of State knows only too well—and not just from me—the contribution that your Lordships’ House makes and will continue to make. I for one certainly appreciate it, as I know he does.

I also thank the noble Baroness, Lady Parminter, for her bravery in sharing her and her family’s experience and anguish of eating disorder. I say the same to my noble friend who shared her experience about her sibling. It is not always easy to do that, but it really brings a lived experience of those around the person we are often thinking about, and it is so important that we do that. This debate has confirmed to me what I knew already—but it is always worth doing it again. It is the product of persistence and of a number of investigations and recommendations. It is also inspired and underwritten by the tireless campaigning that many have undertaken to improve the rights and experiences of people with mental health conditions and learning disabilities and autistic people.

It also reflects the input of those with lived experience, which was first raised as necessary in the debate by the noble Baroness, Lady May. It is about striking the right balance between getting the details of a framework of legislation right, along with the urgent need for reform, and the point that noble Lords have raised about how that is going to be done.

Attitudes and knowledge, as many noble Lords have acknowledged, have changed radically. Mental health is increasingly out of the shadows, and through the Bill we can make sure that legislation does a much better job of keeping up with a shift in societal attitudes and expectations and the development of treatment.

Regarding the role of your Lordships’ House, like the noble Baronesses, Lady May and Lady Barker, I recognise the relevance of this House. I too welcome that the Bill has started its passage through Parliament here because I believe your Lordships’ House will do the job that it is here to do, which is to improve legislation, and this debate today has certainly confirmed that.

In looking at what we are trying to achieve, I am reminded of the words of Professor Sir Simon Wessely in his foreword to the independent review’s final report, where he said that

“we want the Mental Health Act to work better for patients, the public and professionals. We hope that the result will be to reduce the use of coercion across the system, whilst giving service users more choice, more control and better care, even in the event that detention is still required. And we particularly hope that the end result will be to reduce the inequalities and discrimination that still remain”.

Almost six years after the former Prime Minister, the noble Baroness, Lady May, commissioned that independent review, the draft legislation before us speaks to those aspirations as well as delivering our manifesto commitment to modernise the 1983 Act.

On the reduction of detentions, I certainly agree with the noble Baroness, Lady Murphy, and other noble Lords that reducing detentions cannot be achieved by legislation alone. It will depend on having the right services in the community.

New models of care in the NHS are already giving over 400,000 adults greater choice and control over their care. We are also trialling new models of care through six early implementers, bringing together community crisis and in-patient functions into one neighbourhood team that will be available 24 hours a day, seven days a week, to increase access and improve continuity of care in the community. I know from the debate today that many noble Lords are looking for that sort of development and good practice.

As we know, the Bill makes a number of improvements in respect of patient experiences and care, and of the increase of choice and autonomy. It seeks to tackle racial discrimination and provide safety for public, staff and patients, and to provide better support for those with autism and learning disabilities.

I turn to some of the main themes that have been raised. I say to the noble Baroness, Lady Tyler, that we continue to be committed to engaging with those with lived experience. Part of the point of the Bill is that, where those with lived experience have not had their voices heard, I believe our continued engagement will allow that.

On racial inequalities, many have spoken passionately about this matter, including the noble Baronesses, Lady Watkins and Lady Buscombe, and the noble Lord, Lord Adebowale. The racial disparities associated with the operation of the current Act were one of the many drivers of reform, and rightly so. The changes in this Bill will give patients greater say in their treatment and encourage more collaboration and less coercion in care and treatment planning, which are all crucial to reducing inequalities. This will include increasing oversight and scrutiny of community treatment orders, where racial inequalities are at their most acute. It will also be about encouraging the uptake of advance choice documents, where those with lived experience, as I said in my opening remarks, have been very generous in their reference to their use in reducing inequalities. Legislating so that people can choose their own nominated person will also protect rights.

Inequalities in outcomes are not just a result of how the Act has been applied but also due to wider social and economic factors. We will therefore be working across government to ensure that the Bill’s provisions are effectively implemented, aiming to reduce those racial disparities in decision-making under the Act, starting with using the code of practice to make clear which actions can be taken in the application of the Act. We are also taking forward non-legislative reforms recommended by the independent review, including the Patient and Carer Race Equality Framework and also piloting culturally appropriate advocacy models to support those from minority ethnic backgrounds to understand their rights under the Mental Health Act and to give voice to their individual needs.

On the mental health commissioner, I have heard many comments, including those expressed by the noble Baronesses, Lady Murphy, Lady Barker, Lady Buscombe and Lady Berridge, and the noble Lord, Lord Bradley, and others. That is quite a group to address, but I will have a go. It is true that we have not taken forward the pre-legislative scrutiny committee’s recommendation to establish a statutory mental health commissioner. We recognise that improvements need to be made to the quality of care and the patient safety landscape. However, the concerns are that the proposed mental health commissioner’s function would be potentially largely duplicative of existing bodies and functions, and nobody wants to risk diluting accountability or causing confusion. As noble Lords will know, Dr Penny Dash has been asked by the Secretary of State to assess if the current range and combination of organisations within the healthcare regulation landscape is effective and to make recommendations of what might be needed, and I think it is important that we await her recommendations.

Learning disability and autism were raised by a number of noble Lords, in particular by the noble Baronesses, Lady Hollins, Lady Buscombe and Lady Browning, my noble friends Lady Keeley, Lady Ramsey and Lord Touhig, and the noble Lords, Lord Scriven and Lord Adebowale. This is a very important point and I recognise that we want to improve care and support for the over 2,000 people who are currently detained, as well as anybody who may need support in the future. We know from the NHS’s safe and wellbeing reviews that four in 10 people who are detained in this group have needs which could have been met in the community with appropriate support. That is why we are going to be focusing on developing community services and improving the quality of care, which will happen alongside the Bill’s reforms.

Through the Bill, we will be taking forward a package of measures for those with a learning disability and autistic people, so there will be a significant programme of work, alongside investment. I will be pleased to engage with expert stakeholders and those with lived experience, including parliamentarians, and to update your Lordships’ House as we progress.

With regard to the recommendations of the pre-legislative scrutiny committee, there is no doubt in my mind that the Bill has benefited greatly from undergoing scrutiny in 2022. It is a better Bill for that and we have tried to incorporate more of the Joint Committee’s recommendations within it. Many of those recommendations relate to the statutory code of practice and we will consider how we take these forward following Royal Assent.

On the important point of implementation, raised by many noble Lords, including the noble Lords, Lord Adebowale and Lord Bradley, the truth is that we estimate that the full implementation of these reforms will take around 10 years. The speed at which we can implement will be limited by the time that we need to expand and train the workforce. This goes to the point raised by the noble Lord, Lord Kamall, and I am grateful for his honesty in the way that he described previous work on the workforce. I thank him and his ministerial colleagues—predecessors of mine—who have worked on this.

The reality is that while some reforms can commence much sooner than others, we will need to commence powers under the new Bill in phases. Implementation will depend on what happens during the passage of the Bill and the reality of future funding settlements—to the point raised by the noble Lord, Lord Stevens—as well as other developments, such as the 10-year plan, but I can briefly give an indicative timeline.

A small number of reforms relating to the criminal justice elements of the Bill will commence within two months of Royal Assent. In the first year after Royal Assent, there will be a focus on updating the code of practice and creating the necessary secondary legislation to enable implementation. We will need a further year to train existing staff on the reforms and ensure that processes are in place. We would therefore hope to commence the first phase of significant reform in 2027, and to commence further reforms as and when there is sufficient resource in place to do so. In the spirit of honesty, the truth is that for what I would call the most burdensome reforms—for example, the increased frequency of mental health tribunals—those would not be likely to commence before 2031-32.

Alongside the passage of the Bill itself, we are looking closely at implementation in relation to learning disability and autism. Again, the exact timing of implementation of the reforms will depend on future funding. I know that noble Lords will understand that I am limited in what I can say on that, but we have already demonstrated our direction of travel by: treating and resourcing mental health seriously, including having a mental health professional in every school; introducing open-access Youth Futures hubs; recruiting 8,500 mental health workers; and having £26 million in capital investment. Indeed, there is the priority that many noble Lords, including the noble Lord, Lord Crisp, have acknowledged of bringing this Bill forward as a matter of urgency.

The noble Lord, Lord Meston, and the noble Baroness, Lady Berridge, raised the disparity of treatment between children and adults. It is true that there are a small number of reforms which do not apply to children and young people, as was also raised by the noble Baroness, Lady Watkins. It is the case that there is a difference; nevertheless, we are committed to improving children and young people’s autonomy over their care and treatment. We still believe that these reforms will go some way to achieving this. Like adults, under-18s should be supported to share their wishes and feelings by the clinician when it comes to care and treatment decisions.

On the issue of prison transfers, which was raised by the noble Baroness, Lady Watkins, and the noble Lords, Lord Scriven, Lord Bradley and Lord Adebowale, we recognise that operational improvements are needed to ensure the safe and effective implementation of the statutory 28-day limit. NHS England is indeed taking steps to address some of the barriers to timely transfer of patients. The wording in the Bill, which refers to the need to “seek to ensure” a transfer within 28 days, should be sufficiently robust to provide accountability for a breach of that time limit, while recognising that there are multiple agencies involved.

As we know, while this legislation—

[Baroness Berridge (Con)]

I hate to interrupt, given the lateness of the day and the lateness of the hour, but the point that a number of noble Lords were making in relation to children is that this Bill potentially does not sit with the principles under the Children Act. If the Government intend impliedly to repeal parts of the Children Act, then it would be good to have that clarification from the Dispatch Box.

[Baroness Merron (Lab)]

I look forward to coming to that point in Committee. The marrying up of legislation will be important, as is making progress on the Bill. That applies to the point of the noble Lord, Lord Alderdice, and others about fusion. We do not want to hold up this Bill while we make progress, but we will be mindful of the interface with other legislation.

In this Bill we are starting with the most overdue reforms to make the law fit for the 21st century. I very much look forward to working through the Bill in much greater detail in Committee. I am most grateful to all noble Lords who have not just spoken this evening but worked to get us to this point.

Bill read a second time.

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Moved by

[Baroness Merron]

That the Bill be committed to a Committee of the Whole House, and that it be an instruction to the Committee that they consider the Bill in the following order: Clauses 1 to 3, Schedule 1, Clauses 4 to 23, Schedule 2, Clauses 24 to 38, Schedule 3, Clause 39 to 54, Title.

Motion agreed.

Carers and Poverty: Carers UK Report

Baroness Merron Excerpts

Thursday 21st November 2024 Lords Chamber

[Baroness Pitkeathley (Lab)]

I beg leave to ask the Question in my name on the Order Paper and remind your Lordships that today is Carers Rights Day.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, from these Benches I pay tribute to the memory of our dear and noble friend Lord Prescott.

I thank Carers UK for its report, which, importantly, as my noble friend said, is raised on Carers Rights Day. We will take the findings into account as we continue to support unpaid carers, whose major contribution I pay tribute to. We have announced an increase to the carer’s allowance earnings limit. Carers can earn around an additional £2,000 per year. This is the biggest uplift since the allowance was introduced in 1976. Furthermore, we will review the implementation of carers’ leave.

[Baroness Pitkeathley (Lab)]

My Lords, I readily acknowledge the welcome concessions by the Chancellor in the Budget and thank my noble friend for her response. There is never any difficulty in getting recognition for our moral obligation to carers, but figures published this morning by Carers UK remind us of their contribution to the economy. They show that the value of their support is worth £184 billion per year in the UK—directly comparable to the spending on the NHS in the four nations, which is £189 billion. I hope my noble friend understands that it is against this background of their huge economic contribution that we ask for entitlements for carers and for recognition of their rights to lead an ordinary life, to combine paid work with caring, and to not to be condemned to a life of poverty because of their caring responsibilities.

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[Baroness Merron (Lab)]

I very much appreciate the point my noble friend makes, and the point made in this very important report. As well as the increase to the carer’s allowance earning limit, which I mentioned in my initial Answer, there will be an update to the Accelerating Reform Fund, which provides funding to local authorities, including for support for unpaid carers. In addition, the National Institute for Health and Care Research has commissioned an evaluation of unpaid carers’ support funded through the better care fund.

[Baroness Verma (Con)]

My Lords, I declare my interests as set out in the register. Will the Minister look at respite relief for not just unpaid carers but paid carers? There is just not enough respite relief for people who are doing this 365 days a year, and they need to have that. Will the Minister also look at families taking unpaid care work and the winter fuel allowance? This will impact a lot of families, and unpaid carers are usually well over 60.

[Baroness Merron (Lab)]

I understand the point the noble Baroness is making. I was pleased that my ministerial colleagues Stephen Kinnock, the Minister for Care, and DWP Minister Stephen Timms recently attended a Carers UK-hosted round table to discuss all these points, including poverty and finances. I hope your Lordships’ House will acknowledge and welcome the steps we have already taken and be assured that we know there is much more to do. We will continue to work cross-government on this.

[Baroness Tyler of Enfield (LD)]

My Lords, I welcome the recent announcement about the earnings limit on the carer’s allowance, but that helps only carers who are able to combine paid work with unpaid care. It is estimated that over 1.5 million carers are now providing over 50 hours of care per week, making it impossible for them to do paid work. What are the Government doing to support those carers? Will they look at increasing the carer’s allowance, which is currently £81.90 a week—the lowest benefit of its kind, I believe—and expanding the care-related premium to universal credit and pension credit?

[Baroness Merron (Lab)]

There is to be an increase in the carer’s allowance from April of next year. The change we have made in the earnings limit will, over the next four to six years, bring in an additional 60,000 people who were previously not eligible. The DWP is very conscious of a number of the pressures on unpaid and other carers and will continue to look at that. Further developments will be reported.

[Baroness Watkins of Tavistock (CB)]

My Lords, has further consideration been given to reducing or having an amnesty on repayments by carers who were overpaid due to the complex algorithm involved in being able to work for a certain amount of money? Having acknowledged that they should be able to earn at least another £2,000 without such a disadvantage, could we not cancel the situation for many, particularly over this winter, before the new carer’s allowance comes in?

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[Baroness Merron (Lab)]

I and my ministerial colleagues are extremely aware of the anxiety the overpayments have created, and they are being independently reviewed to establish exactly why they happened. While I cannot commit to the amnesty the noble Baroness asks for, I can assure her and your Lordships’ House that we and the DWP are working to be as sympathetic to people as possible. I urge anyone in receipt of carer’s allowance to inform DWP of a change in their circumstances, so that overpayments can be avoided in future.

[Lord Kamall (Con)]

My Lords, we on these Benches also add to the tribute to the noble Lord, Lord Prescott, who has passed away.

My noble friend Lady Verma referred to the stress unpaid carers are under. We know that unpaid carers who look after family members may themselves have mental health issues, or may be looking after people with such issues. What support do the Government currently provide for the mental health of unpaid carers and those they care for, and what extra measures do they plan to introduce?

[Baroness Merron (Lab)]

One of the key things in all this is the identification of carers. As has been discussed in your Lordships’ House on a number of occasions, a lot of people do not identify as carers. Therefore, we are encouraging GPs and, in the case of young carers, schools, to identify carers, so that they can get the support they deserve. The noble Lord, Lord Darzi, identified that making sure that unpaid carers receive recognition and support is key, and it will be in the 10-year plan as we go forward.

[Baroness Keeley (Lab)]

My Lords, I want to raise the issue of the 21-hour study rule whereby an unpaid carer is not allowed to claim carer’s allowance and be in full-time education of more than 21 hours a week. I cannot see a good reason for that rule. It would be very welcome if the Labour Government changed the rule to allow unpaid carers to study without losing their carer’s allowance.

[Baroness Merron (Lab)]

I thank my noble friend for that and can assure her that I will be discussing that very point with ministerial colleagues and am happy to return to her on it.

[Baroness Altmann (Non-Afl)]

My Lords, particularly today, will the Minister join me in paying tribute to all carers and care workers, paid or unpaid? Does she agree that, with an ageing population, it is long past time to stop treating care as some kind of second-rate service and to give it parity with the NHS? It saves the NHS significant amounts of money, and carer’s allowance is extremely low. Following the recent Budget, care charities will still have to fund the extra national insurance costs, even though NHS workers are exempt.

[Baroness Merron (Lab)]

I, of course, join all noble Lords in paying tribute to care workers, whether paid or unpaid. On paid care workers, that is one of the reasons why, as we move towards a national care service, we have for the first time laid legislation to ensure that there will be a fair pay agreement. On national insurance contributions, I can assure the noble Baroness that the Chancellor considered all the implications of the measures that were announced in the Budget when settlements were made. Further details of those will be announced in due course.

NHS: Treatment of Children from Other Countries

Baroness Merron Excerpts

Thursday 21st November 2024 Lords Chamber

[Lord Hogan-Howe]

To ask His Majesty’s Government what policy they have in relation to the treatment of children from other countries who have life-threatening and rare diseases for which high-quality treatment is available on the NHS.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, no specific government policy exists for treating children from other countries with life-threatening or rare diseases and it is generally preferable to treat patients close to home, subject to capacity and expertise. Some UK international healthcare agreements, mostly with Europe, the British Crown dependencies and overseas territories, permit doctors to refer patients to the UK. Referrals are usually reimbursed and happen when wait times are excessive or the treatments are not available in the child’s home country.

[Lord Hogan-Howe (CB)]

I thank the Minister for the reply. This really is a Question about trying to inspire the NHS at a time when it probably most needs it. Professor Owase Jeelani is a consultant paediatric neurosurgeon based at Great Ormond Street. His worldwide speciality is the separation of conjoined twins who are unfortunately joined at the head. He has now carried out nine of these operations, obviously affecting 18 children, and, because of the frequency, his success rate and the outcomes have improved over time. More recently, four of the nine operations were carried out abroad. If they are carried out at home, £1 million has to be raised every time to pay for them, which the professor ends up having to do. Alternatively, he and his team have to travel abroad, which means that he spends less time operating at Great Ormond Street in other specialities on children who need his support. Is the Minister prepared to meet the professor to see whether there is any better way of dealing with these problems, which are rare? It is of course an international problem and the babies affected have no hope unless someone does this.

[Baroness Merron (Lab)]

The noble Lord shines a light on the rarity of this condition as well as its importance. I would of course be happy to meet the professor. The noble Lord will know from our own discussions that this is an extremely complex area across the NHS and there is, as I said in my Answer, no overarching UK approach. Rightly, this is a trust-led approach because trusts have to make decisions about the balance between specialist work and other work, including the reduction of waiting lists.

[Baroness Manzoor (Con)]

I support the premise of the Question. Can we look at the NHS supporting these cases? From my perspective it is vital for three reasons. First, it is inspirational on the world stage for the NHS. Secondly, it retains expertise in the NHS. Thirdly, it offers the soft diplomacy powers that we need internationally. I urge the Minister to look at this again to see if the Government can find a way round it.

[Baroness Merron (Lab)]

I will be glad to take back to the department the comments of the noble Baroness and the noble Lord, but I reiterate that it is individual expert centres that are responsible for liaising with referring clinicians. By definition this has to be done on a case-by-case basis because we are talking about highly specialised treatments for rare diseases. Again, there is no set nationwide policy for local implementation because of the very nature of the challenge and the specialism to which the noble Baroness refers.

[Lord Scriven (LD)]

My Lords, maybe a good place to start would be to be bolder and more ambitious with the rare diseases framework that already supports international collaboration as part of the Government’s policy. As part of this framework, will the Minister investigate setting up an international centre of excellence in the UK that could be funded by both the UK and international partners for procedures and R&D to be carried out here, which would deal with some of the problems that both noble Lords have mentioned?

[Baroness Merron (Lab)]

The noble Lord is right to make reference to the UK rare diseases framework. The intention of that is to improve the lives of those with rare diseases—for example, by helping to get a faster diagnosis, increasing awareness of rare diseases, better co-ordination and care, and improving access to care, treatment and drugs for those in this country. I will add his suggestion to the list of matters to raise with the department.

[Lord Kamall (Con)]

My Lords, we can all be proud that the UK is home to some of the world’s best medical experts on rare conditions. As the noble Lord, Lord Hogan-Howe, said, there are patients in other countries—often poorer countries—who seek the help of a UK expert. The Minister knows that in the UK the NHS charges, understandably, and that is welcome, but there are other challenges if that expert goes abroad. She spoke about some international agreements in an earlier answer, so can she say a bit more about how NHS England works with other systems in other countries, especially with reference to some of those agreements?

[Baroness Merron (Lab)]

The agreements that the UK has in place which contain referral arrangements whereby the funding is discussed and agreed as part of the process of the referral are with the member states of the EU, Switzerland, the EFTA-EEA bloc of countries, the British Crown dependencies and some overseas territories. As the noble Lord rightly acknowledges, it is only fair that those using the NHS are those contributing to it, and we therefore have to ensure that we stick to those agreements. If trusts seek to undertake work outside of that area, that will be a matter for individual trusts, which will have to make decisions about their funding and their requirements to serve the NHS.

[Lord Beamish (Lab)]

Will my noble friend the Minister join me in congratulating the heart transplant unit at the Freeman Hospital in Newcastle, particularly the unit which conducts children’s heart transplants, providing a great service not just for this country but for children from across the world? One of the issues, though, is trying to encourage donors to come forward. What more can be done to encourage donors, specifically children, to come forward?

[Baroness Merron (Lab)]

I am very happy to add my congratulations to the hospital, which my noble friend knows very well. There are several approaches that we take on donors. One is the increased use of technology to ensure that organs donated can be used when and where needed. We tend to lose a lot of organs because that is not possible to do, depending on the technology. Another approach is to ensure that organ donation is a route that people are assured they can take, feel confident in, and are willing to participate in, including where somebody has died and we must deal very delicately, of course, with their loved ones.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a member of the board of NHS England. Clearly we need to meet the needs of our own population at the moment but also need to retain staff, and there could be a real opportunity for working with the overseas development aid budget to enable exchange sabbaticals between Commonwealth countries and staff here in relation to these special services, so that children from Commonwealth countries who otherwise would not have access to these rare treatments could do so both here and abroad. Could the Minister talk with the ODA department to see whether such an initiative could be developed?

[Baroness Merron (Lab)]

I will certainly ensure that officials take up the suggestion of the noble Baroness to explore possibilities.

[Lord Lansley (Con)]

My Lords, one of the reasons why people are envious of the NHS is because we are able to do things through the NHS which are not necessarily able to be supported in other countries by private medical insurance, and we have the benefit here of some of the finest clinicians in the world. That is something I am sure the Minister will want to focus on when she meets Professor Jeelani. There will doubtless be very specific ways in which he and his team might be helped, but could she bear in mind the fundamental principle that only about one in three million babies is in this condition and they have no hope other than to be treated by his excellent team? That is a responsibility, regardless of residence and those definitions, that we probably take on board through the NHS.

[Baroness Merron (Lab)]

I understand the point that the noble Lord makes and am sympathetic to it. He will also understand the need to ensure not only that we have the expertise here and use it correctly, but that the payment is in place so that the areas of excellence can also meet the requirements of other demands on them, including the reduction of waiting lists. He knows that it is a very delicate balance and that is why it is right that this is a trust-based approach, but I will certainly bear that in mind when I meet the professor.

Type 2 Diabetes: Continuous Glucose Monitors

Baroness Merron Excerpts

Tuesday 19th November 2024 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords—

[Noble Lords]

Hear, hear!

[Baroness Merron (Lab)]

I could get used to that reception, but I am not sure that I will get used to three Questions and a repeat UQ. However, I thank your Lordships’ House.

More than 200,000 eligible people living with diabetes currently benefit from real-time CGM, or continuous glucose monitoring. CGM data-reporting systems are being developed to aid the delivery of rollout by integrated care boards. Alongside this, the data is collected as part of the national diabetes audit. From 2025-26, NHS England plans to publish that data routinely on the audit’s quarterly dashboard, which will provide the insights that ICBs need, including data on CGM uptake, variation and health inequalities.

[Lord Rennard (LD)]

Many more people with type 2 diabetes could benefit from this technology. People living in deprivation and people of black and south Asian ethnicity are more likely to develop type 2 diabetes, are less likely to receive essential diabetes care and experience worse health outcomes. However, according to Diabetes UK, only 24 of 42 integrated care boards in England have a policy for continuous glucose monitoring for people with type 2 diabetes that is in line with guidance from NICE. How will the Government ensure equal access to such monitors for people with type 2 diabetes?

[Baroness Merron (Lab)]

The noble Lord makes a very fair observation. Work is going on in a wider equality monitoring programme exploring how to keep an eye on equality repercussions, including ethnicity, by reference to protected characteristics in the Equality Act 2010. Importantly to the point he raised, the review includes consideration of how NHS ethnic group categories can be updated. The outcome of the review—this is the point I really want to emphasise—will ultimately guide a process of reducing inequalities, but I accept his challenge and his point.

[Lord Patel (CB)]

My Lords, there is a strong link between body mass index, BMI, and type 2 diabetes. People with a body mass index of 25 to 30 have an 8% chance of developing type 2 diabetes; those with 30 to 40 have a 20% chance; and those with a body mass index of 40 or over have a 40% chance. One way of monitoring long-term glycaemic glucose levels is to measure haemoglobin A1C. It might therefore be an idea to use haemoglobin A1C levels to diagnose early type 2 diabetes, initially in people with a BMI of 40 or over, as a screening tool. It might be an idea to ask NICE or the screening committee to evaluate that likelihood.

[Baroness Merron (Lab)]

The noble Lord makes a helpful point. I can tell your Lordships’ House that diabetes testing is included as part of the NHS health check. If a person is identified as being at high risk of type 2 diabetes, they should be offered a blood sugar glucose test or a fasting glucose test. NICE produces guidelines on preventing type 2 diabetes in people at high risk, and that includes recommendations on risk assessments, including blood testing, which can include people with a high BMI. His point is extremely valid, some of that is in place and we will ensure that it continues.

[Baroness Foster of Aghadrumsee (Non-Afl)]

My Lords, I am sure the Minister agrees that access to a GP is critical, whether that is in detecting and monitoring diabetes or, in relation to the first Question, detecting and monitoring cancer. Would she be surprised, therefore, that in Northern Ireland it is almost impossible to access a GP at present? Indeed, it is at an all-time low. Will she consider doing a comparative study across the United Kingdom to look at access to GPs because, unfortunately, I believe it is not a very good story at all.

[Baroness Merron (Lab)]

I hear what the noble Baroness says and I am glad to report that I met the Northern Ireland Health Minister recently, along with colleague Peers, to discuss a range of matters including differences across the nations. I will consider the point that she makes.

[Lord Kamall (Con)]

My Lords, while the original Question was about type 2 diabetes—as the noble Lord, Lord Patel, said, type 2 diabetes can be due to lifestyle and can sometimes be reversed—I want to ask the Minister about type 1 diabetes. Its exact cause is unknown and people can get it at any time of their life, yet there is no cure, so in some ways the need for CGM is more critical. The charity Breakthrough T1D, which represents type 1 diabetics, finds that black, Asian and minority ethnic groups in England and Wales and lower socioeconomic communities are much less likely to get access to or use these technologies. Closing that gap was one of the issues that we grappled with in government, so can the Minister tell the House what plans there are to ensure that as many type 1 diabetes patients as possible across England receive access to continuous glucose monitoring?

[Baroness Merron (Lab)]

It is probably important to say at the outset that type 1 diabetes, as the noble Lord knows, is not related to lifestyle issues, and at this point cannot be prevented, so it is a case of management. The technology that is available now is quite remarkable— not just the CGMs that the noble Lord, Lord Rennard, inquired about, but also hybrid closed loop systems, where the CGM is paired with an insulin pump, so it is administered automatically without the person having to calculate. I think that is incredibly helpful. It is only available to those eligible, with type 1 diabetes, but the rollout began in April 2024. The noble Lord makes a good point, as did the noble Lord, Lord Rennard, about access and inequality in access. That is something we continue to work on, ensuring that everybody can fairly access these wonderful technology advancements.

[The Lord Bishop of London]

My Lords, women with type 2 diabetes face a higher risk of miscarriage, stillbirth, neonatal deaths and birth defects. As we have heard, women who live in areas of high deprivation as well as women who come from black and minority ethnic groups are more likely to be impacted by type 2 diabetes. This compounds the existing inequalities in the maternal mortality rate. What steps are the Government taking to support integrated care boards to build relationships with these women who are most likely to experience these impacts, to ensure that they have the best maternity care and diabetic care, including ensuring they have access to continuous glucose monitoring where necessary?

[Baroness Merron (Lab)]

The right reverend Prelate is quite right in what she says, including that responsibility for CGM implementation rests with integrated care boards. It is their responsibility to ensure that the technologies we are talking about can be accessed by all eligible patients regardless of their ethnicity or their indices of multiple deprivation. I assure the right reverend Prelate that achieving that equality of access in all diabetes technology is an absolute priority. We will continue to monitor progress and encourage ICBs to do that by the NDA quarterly dashboard in 2025-26. In other words, we will give ICBs the tools to do the job they need to do.

[Baroness Humphreys (LD)]

My Lords, the use of CGMs makes diabetes easier to manage, as they give not only instant information about blood sugar levels but also indicate whether levels are rising or lowering. The DVLA, however, insists on two-hourly glucose monitoring by the traditional finger pricking method when driving on long journeys. Does the noble Baroness envisage a change in this guidance in the near future?

[Baroness Merron (Lab)]

I must confess that is something that I will need to look into—it may be with my ministerial colleagues in the Department for Transport. But I will look into it, and I will be pleased to write to the noble Baroness.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, as part of ongoing research, would my noble friend talk to her ministerial colleagues about possible research that is required into the causes of type 1 diabetes, and if more updated research could therefore provide new types of technologies and treatment? There is no particular cure at this moment in time, and people live with it on a daily basis, hour by hour.

[Baroness Merron (Lab)]

Through the National Institute for Health and Care Research, £206 million was awarded to diabetes research in the last five years through its research programme. The NIHR and Diabetes UK have developed a joint strategy which will inform diabetes research in the UK. I hope that can get us to the place that my noble friend refers to.

National Carers Strategy

Baroness Merron Excerpts

Tuesday 19th November 2024 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we are committed to supporting unpaid carers through our renewed vision for adult social care and the 10-year plan for the National Health Service. We have already taken action to increase the carer’s allowance earning limit, meaning that carers can earn around £2,000 a year more without affecting their entitlement. We have heard the calls for a national carers strategy and will continue to work collaboratively across government to ensure that unpaid carers are visible, valued and supported.

[Baroness Keeley (Lab)]

I thank my noble friend the Minister for that reply, particularly on cross-governmental working, because I think that is one of the most important aspects. The Labour Government’s first national carers strategy was launched in 1999 by the Prime Minister, Tony Blair. The second strategy in 2008 had the support of Gordon Brown and seven Secretaries of State, because evidence from unpaid carers had shown that support for carers could not be solved by one government department but needed work across several. Sadly, Conservative Governments after 2015 did not continue with the national strategy, preferring a much less effective carers action plan. Carers are partners in care, so will my noble friend the Minister consider the strength of feeling among carers and their support organisations that they need and deserve a high-level strategy across government departments to support them?

[Baroness Merron (Lab)]

I certainly agree with the emphasis that my noble friend is putting on the need for cross-government working. I know she has been a champion of that for many years in the other place and that she will continue in your Lordships’ House to ensure that unpaid carers are properly supported and recognised. I can tell my noble friend that Minister Kinnock, as the lead Minister for unpaid carers, regularly engages with those with lived experience, the organisations that represent them and—importantly to the point my noble friend is making—with Ministers from other government departments, most recently the Department for Work and Pensions. We will be formalising our cross-government working with relevant departments and NHS England.

[Lord Laming (CB)]

My Lords, if the Government are going to achieve their ambition to delay admissions to hospital and get people out of hospital more quickly, does the Minister agree that we have got to have proper support for carers? In particular, we should enable them to feel valued for what they are doing on behalf of their family and society as a whole.

[Baroness Merron (Lab)]

I agree with the comments and observations of the noble Lord. I would like to put on record, as I know many Members of your Lordships’ House would want to do, my thanks for and acknowledgement of the role that unpaid, as well as paid, carers play. They are the difference between quality care and less than optimal care. Their support is greatly valued, so I thank the noble Lord for making that point.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I declare an interest as chief executive of Cerebral Palsy Scotland. Disabled adults of working age tell me that one of the reasons they have to fall back on family and unpaid carers is the dire shortage of availability of good PAs to help them work and live. Can the Minister confirm that the national carers strategy will look at access to PAs for working-age adults?

[Baroness Merron (Lab)]

I do have to say to the noble Baroness that I have not committed to a national carers strategy. However, in our joined-up approach, we will certainly be looking at what is needed. That will be very much part of our considerations on the workforce strategy, which Minister Karin Smyth will be leading on. It is crucial to the delivery of services.

[Baroness Pitkeathley (Lab)]

My Lords, would my noble friend agree that one of the major problems suffered by carers is recognition, not just by other people but by themselves? They say, “I am a wife”, “I am a husband”, “I am a mother”, “I am a daughter” or “I am a son”, not “I am a carer”. Therefore, a very high-profile national strategy led from the very top—previously, two Prime Ministers took this on board—would be extremely useful in helping carers recognise themselves and therefore putting them in touch with services that could support them.

[Baroness Merron (Lab)]

My noble friend, who is a very impressive campaigner on the rights of carers, is right to talk about recognition. Of course, if one does not understand that one is a carer, it is hard to access support. I certainly agree on that point. There is guidance, for example, to support GPs in recording which of their patients are unpaid carers, to ensure that they get access to the support they need. Importantly—this has been raised a number of times in this House—in respect of young carers, there is guidance for GPs and it has recently been added to the school census, so young carers can be identified in order that there can be an assessment of needs. So it is true that we need to identify in order to support. Part of that is people recognising themselves as carers.

[Lord Kamall (Con)]

My Lords, I also pay tribute to the work of the noble Baroness, Lady Pitkeathley. I learned much from her when I was the Minister. The Minister may recall that, in April 2023, the previous Government set out the better care fund framework. This included £100 million to accelerate digitisation in the social care sector. This would enable the Government and NHS England to collect valuable data about the state of social care and identify gaps if the Government decide to deliver a national strategy. What plans do the Government have to continue and expand this vital process of digitisation across the care sector, hopefully in delivering a national strategy?

[Baroness Merron (Lab)]

It is indeed the case that using technology and digital advance is key in all the areas where we are working, and the noble Lord will know that in the 10-year plan one of the three pillars will be, for example, going from analogue to digital. On that point, plans for going forward in dealing with social care, which is much needed in this country, will be set out in due course. I assure your Lordships’ House that it will be done through a cross-party approach, involving those with lived experience and the many voices and organisations that are part of the social care sector. We are keen that it is something that we can all get behind.

[Baroness Burt of Solihull (LD)]

As the Minister has said, the carer’s allowance was increased in the Budget by what can only be described as a modest amount, but it remains at one of the lowest levels for any benefit in the UK today. No help has been given to any carer who inadvertently overclaimed, even by £1. If the Government chose, they could stop collecting the overpayments while the independent review that they have commissioned takes place. Carers saddled with returning this money are struggling and suffering now. Why cannot the Government give them a break?

[Baroness Merron (Lab)]

I understand the point that the noble Baroness is making. Certainly we recognise that overpayments have caused people great anxiety. That is why it is important to review the circumstances independently, so we can find out exactly what went wrong and make things right, so it does not happen again. The main message I would give is to urge anyone in receipt of carer’s allowance to inform the DWP of any change in their circumstances in respect of the earnings limit, so that overpayments can be avoided. But we are seeking to work constructively to ensure that this is not an ongoing problem.

[Baroness Lister of Burtersett (Lab)]

My Lords, a key element of any carer’s strategy, or non-strategy, must be to make it easier for carers to combine caring with paid work. As well as long-overdue reform of carer’s allowance, there is wide agreement that carer’s leave needs to be paid if it is to be effective. Will the Government therefore consider introducing it, at least in principle, as part of the Employment Rights Bill, rather than leaving it to a review?

[Baroness Merron (Lab)]

The Government are committed to reviewing the implementation of carer’s leave—and also examining the benefits of introducing paid carer’s leave. As my noble friend said, the Employment Rights Bill includes provisions that will support all employees to support a better work/life balance by making flexible working the default, unless it is not reasonably feasible. That gives us an opportunity to make a particular difference for those combining work with unpaid care. Certainly, we are looking at the benefits of introducing paid carer’s leave, and I look forward to updating your Lordships’ House.

National Insurance Contributions: Healthcare

Baroness Merron Excerpts

Tuesday 19th November 2024 Lords Chamber

[Lord Kamall (Con)]

My Lords, unintended consequences have plagued policymakers and Governments for many years. I am interested in whether the impact on primary care providers, hospices and care homes was a deliberate or unintended consequence of the recent rise in employers’ national insurance. Did the Government conduct an impact analysis of the cost to primary care providers, hospices and care homes before the Budget? If not, have they conducted one since or do they intend to do so? Can the Minister assure non-state providers of primary care, hospices and care homes that this was not a deliberate measure to squeeze them out of the health and care space and that the Government will consider appropriate measures to ensure that they can continue to be financially viable and invest in facilities, staff and front-line services?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

I assure the noble Lord that there is no intent to squeeze out any providers, which are much valued and appreciated. We will continue to listen to their concerns and consult them as we make allocations, which is, as he knows, the usual practice for every Government. On the Budget settlement for the Department for Health and Social Care for 2025-26, I assure him that the Chancellor considered the impact of all the changes in the Budget.

[Lord Scriven (LD)]

My Lords, the net cost to the already struggling community pharmacy sector from the national insurance changes is roughly £50 million. One community pharmacist told me last week that this means that they either reduce services to patients by closing for the equivalent of one day a week or make one and a half members of staff redundant. What advice would the Minister give to that community pharmacist and many others in her situation?

[Baroness Merron (Lab)]

What I would say to each sector, including pharmacists, about the services they provide and what is expected in return from any contract is that, as in previous years—I emphasise that it is business as usual in this respect—employer national insurance contributions are dealt with as part of the process. We are very appreciative of the pharmacy sector’s contribution, not least because it will assist with one of the three pillars in moving from hospital to community services. I encourage all pharmacists to work with us to achieve what I believe they and we in government want: a service that is fit for the future.

[The Lord Bishop of St Albans]

Can the noble Baroness help us understand the huge impact this is having on the hospice movement, which is an extraordinary sector? We get an incredible service from it but, ironically, while we are having a national debate on assisted dying—some of us prefer to call it assisted suicide—this will make it even more difficult to provide this much-valued service. Is there not a case to be made for special support for those independent hospices which have to raise massive amounts of money from charitable sources, so that we are not penalising them?

[Baroness Merron (Lab)]

As the right reverend Prelate is very aware, most hospices are indeed charitable. They are independent organisations that receive some statutory funding for providing NHS services. As we discussed in a recent debate in your Lordships’ House, the amount of funding that charitable hospices receive varies by integrated care board area, and that will depend in part on population need and the breadth and range of palliative care and end-of-life care provision within the ICB footprint. With NHS funding being provided on a tariff basis, as is usual every year, there is NHS planning guidance, a local government finance settlement and consultations with independent providers. That will happen this year as it has every single year under every previous Government.

[Baroness McIntosh of Pickering (Con)]

My Lords, the Minister is aware of my interest with the Dispensing Doctors’ Association. The idea that allocations will be made in due course simply will not wash. GP practices, care homes and pharmacies will close their doors if the Government do not act urgently.

--- Later in debate ---

[Baroness Merron (Lab)]

Under previous Governments, including her own, this was exactly what happened, and it will continue to happen. There are established processes on NHS guidance and the national tariff system, and there will be consultations on primary care contracts, which will play out in the normal—and what I regard as a fair and open—way. I make that point in respect of all Governments, not just this one.

[Lord Clarke of Nottingham (Con)]

My Lords, the root of this problem is that, in an election that the Labour Party was bound to win, it made a promise that it would not raise income tax, national insurance or corporation tax. The taxes it promised not to raise provide 70% of the Government’s income and are the basic toolbox of any Chancellor in any Budget. They sometimes go up or down according to the economic needs of the nation, and they are the broadest-based and fairest taxes. Now that the Government have imposed these rather damaging taxes to raise revenue in this last Budget and have gone for the choices they have, can I have the Minister’s assurance that this promise is not good for the next five years? It will confine the Government’s ability to raise revenue when they need to, so they will go into more areas and will do unintended damage to employment or particular sectors of the economy.

[Baroness Merron (Lab)]

I appreciate hearing the view of the noble Lord, with his considerable experience, but this is a place where I know the current Chancellor would beg to differ. I gently point out that I believe the root cause is something rather different: this Government inherited a £22 billion black hole.

[Noble Lords]

Oh!

[Baroness Merron (Lab)]

Noble Lords may wish to groan and comment, but it is a fact. The deficit that the previous Government ran up in my department alone would mean 20,000 fewer appointments per week. That compares very unfavourably with the 40,000 more appointments that this Government are promising.

[Lord Foulkes of Cumnock (Lab Co-op)]

Does my noble friend agree that we are all getting a bit fed up with the groans from those on the other side when we take the time to remind them of the appalling debt we inherited? It is a truth that has been independently verified that we inherited this £22 billion. They are unwilling to admit the truth. Does she also agree with the noble Baroness, Lady Taylor of Stevenage, that we are putting forward proposals that they, understandably, constantly attack, but that they will not put up alternative proposals for dealing with the debt we have inherited?

[Baroness Merron (Lab)]

I certainly agree with the comments of my noble friend Lady Taylor, who set out the government response very clearly in the last Question. I also share the view of my noble friend Lord Foulkes that it is important to be honest; I believe we have taken that on board as a new Government. That is why, for example, we commissioned the independent review by the noble Lord, Lord Darzi, to find out the state of the NHS in order that we could move forward. What the noble Lord found did not make for pretty reading, and it is our job to put this mess into a rather better shape than it is now.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, what has been described as “groans” might, in another language, be described as holding a Government to account. The Government are in charge now and have to answer the charges as put.

If the Minister is correct that the Treasury evaluated what the changes to employers’ national insurance contributions would be, the Government will have known that this was going to affect not just big nasty bosses but a wide range of employers—hospices, care homes and all sorts of charities. The hairdressing sector is being decimated as we speak. I just went and stood in the rain for two hours at the farmers’ demonstration, where tenant farmers pointed out that these national insurance changes will mean they will have to sack farm workers. This is having a wide decimating impact. If the Government are going to be honest, I hope they will talk to each and every one of the sectors and tell them that this is going to be resolved one way or another.

[Baroness Merron (Lab)]

This Government are very committed and are indeed talking to all sectors, including in my own department. As to the point the noble Baroness rightly raises about holding Governments to account, I welcome that. It gives me and my noble friends an opportunity to set out the plans, responsibilities and concerns of this Government. We will take them seriously and continue to work to get consensus wherever we can.

Cancer: Older People

Baroness Merron Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what steps they are taking to ensure a UK-wide approach to improving outcomes for older people with cancer.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, sadly, the risk of developing cancer increases as a person gets older. Health is a devolved matter, as your Lordships’ House will know, and the department is working with the NHS in England to improve outcomes for people of all ages with cancer. On my noble friend’s specific point, we are working to bring England in line with other nations by delivering a new national cancer strategy next year following the publication of the 10-year health plan.

[Baroness Ritchie of Downpatrick (Lab)]

I thank my noble friend for her Answer. I am sure she is aware that the UK’s cancer burden is projected to rise by around one-third by 2040, and 60% of those cancer diagnoses are expected to be among those aged 70 and above. Yet there is evidence that older people’s cancer care is not always provided to the level that it should be. Therefore, what assurances can she give me of actions the Government will take as part of the forthcoming cancer plan and the 10-year NHS plan to address these health inequalities in cancer care and treatment throughout the UK?

[Baroness Merron (Lab)]

My noble friend is quite right that the incidence of cancer is expected to rise across the UK, especially in older people. I agree that older people can face specific barriers when accessing care. Following on from the independent review by the noble Lord, Lord Darzi, I assure my noble friend that the 10-year health plan and the subsequent cancer strategy for England, both to be published next year, will help us do more to prevent cancer, identify it early and treat people quickly. They will have regard to older people.

[Lord Patel (CB)]

My Lords, I am delighted to hear that we will have a new cancer strategy. I have tried to get a debate in this House on that for two or three years now. Maybe the Minister will use her influence with the powers that be so that we can have a government-led debate on the cancer strategy. However, one of the reasons why our outcomes are poor is late diagnosis of cancer. Only 54% of cancers are diagnosed at stages 1 and 2. What plans do the Government have to improve early diagnosis of cancer?

[Baroness Merron (Lab)]

I am sure the powers that be heard what the noble Lord said about a debate. On the point he raised, I absolutely agree that diagnosing cancer earlier, at stages 1 or 2, improves outcomes and survival. I refer again to the report by the noble Lord, Lord Darzi: we need to do more to diagnose people at an early stage. Work is already being undertaken to improve cancer screening uptake. We will continue to roll out targeted interventions such as the lung cancer screening programme, which has a particular effect and impact on the most disadvantaged areas. Members of your Lordships’ House will know that the Budget also committed to £1.5 billion of capital funding for new surgical hubs and diagnostic scanners, which will increase capacity.

[Lord Kamall (Con)]

My Lords, I will carry on the thread of questioning that the noble Lord, Lord Patel, started about early diagnosis. As the Minister said, it is very important that we look at early diagnosis. Noble Lords who are interested in diagnosis were looking forward to a follow-up report to the 2020 community diagnostic centre review by Sir Mike Richards. That was due to be published before the Budget, yet the Health Service Journal has reported that it has been shelved. Is this true? If so, can she explain why?

[Baroness Merron (Lab)]

It is important that we concentrate on the biggest ever NHS consultation, because that will lead us to the 10-year plan, and all that we are doing will sit within that. As the noble Lord will know, we are committed to getting the NHS to diagnose cancer earlier, treat it faster and improve waiting times. One of the announcements in the recent Budget, which also shifts the dial, is that we will deliver an extra 40,000 scan appointments and operations every week. The 10-year health plan will set out our approach for shifting healthcare from sickness to prevention, including reducing the incidence of cancer.

[Baroness Burt of Solihull (LD)]

My Lords, my mother-in-law died riddled with cancer that was not diagnosed until the very end of her life. We know that older people often suffer from several conditions and that frailty may minimise the treatment options available. The comprehensive geriatric assessment is the gold standard for the assessment of older patients and can make a real difference in outcome and cost, but cancer is not embedded in that assessment. Will the Minister find out from clinicians whether that might be possible?

[Baroness Merron (Lab)]

I give my sincere condolences to the noble Baroness and her family. Yes, I will raise that. It is a good point to look at, and I thank her.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, what plans do the Government have, if any, to include older people in routine screening programmes, particularly given all the statistics that we have heard in the course of this Question and others? I have asked this question before. I have never heard an answer that I found entirely convincing. I am confident my noble friend will be able to help on this occasion.

[Baroness Merron (Lab)]

I thank my noble friend for her confidence, and I will do my best. Decisions on screening, including the age ranges at which they operate, are made by the UK National Screening Committee. They have an upper and a lower age limit, which are based on evidence and kept under review. Current evidence does not support making changes to these ages. For breast screening, for example, self-referral is available for those over the age of 71 and for bowel screening it is available for those over 75. I confirm to her that this is all evidence-based, and we always keep an eye on the continuing evidence.

[Lord Lansley (Con)]

My Lords, I declare an interest in that I am a happy statistic of having survived more than five years after cancer treatment. But I know that I am not alone and that many others of the near 2 million cancer survivors have chronic conditions resulting either from cancer or from its treatment. Will the cancer strategy recognise and offer support to the many cancer survivors who have continuing chronic conditions resulting from their cancer?

[Baroness Merron (Lab)]

I am glad that the noble Lord is, as he describes himself, a happy statistic. We are all grateful for that. I certainly share the view that there are a number of ongoing chronic conditions and impacts on other aspects, such as people’s mental health. The cancer strategy needs to look at this in its development, and I am grateful to him for highlighting it.

[Baroness Pitkeathley (Lab)]

My Lords, as another happy statistic, I ask whether my noble friend thinks that older people are perhaps more reluctant than our younger friends to mention symptoms and are more inclined to say, “Oh, it’s nothing; I’ll get over it”. Would more public education programmes be useful in this regard?

[Baroness Merron (Lab)]

I am glad that my noble friend is also a happy statistic—although I see all noble Lords as more than just statistics. She makes a very good point but it is not just about those who are older; many people are reluctant to consider taking action when they have symptoms. My request to them is that they do not wait and that they act. That is how we get things diagnosed earlier, to provide the right support and care. There is a lot of embarrassment about certain symptoms and I make the plea that people should not be embarrassed. Certainly, as she suggests, the new cancer strategy will take account of how we educate people as well as diagnose and treat them.

Support for Infants and Parents etc (Information) Bill [HL]

Baroness Merron Excerpts

3rd reading
Friday 15th November 2024 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I thank the noble Lord, Lord Farmer, for bringing this Bill to the House and for meeting me to discuss it. I have no doubt whatever that he will continue to advocate for children’s health with his customary passion and dedication. I am also thankful to the noble Baroness, Lady Berridge, for enabling today’s debate.

This Government are committed to raising the healthiest generation of children in this nation’s history. However, as I expressed at Second Reading, while the intentions of the Bill are good, we need to be able to deliver a package of support for infants, children and families that is comprehensive rather than piecemeal. Through our mission-led approach, the Government will drive long-lasting and sustainable change for babies and children. As the Prime Minister has confirmed, in the coming weeks, we will publish clear ambitions for each mission, putting the health and well-being of our children at the heart of everything we do.

While we cannot support the Bill of the noble Lord, Lord Farmer, I can assure your Lordships’ House that we will continue to work tirelessly to improve the lives of babies and children right across the country.

A privilege amendment was made.

Diets: Fat

Baroness Merron Excerpts

Thursday 31st October 2024 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I thank the noble Lord, Lord McColl, for bringing this important issue to the fore. He is a doughty campaigner and I know he has many strong views, to which I have listened not just on this occasion but on many occasions. I welcome the airing that we are having today. I thank other noble Lords, too, for their contributions. As ever, there is a fair amount of common ground and quite a bit of divergence in the opinions about how we tackle what is an obesity crisis. I particularly thank noble Lords, including my noble friend Lord Mitchell and the noble Lord, Lord Rennard, for sharing their very personal experiences; that always assists us.

As many noble Lords have said, there is no doubt that obesity is significant in our country—and not just our country. As the noble Lord, Lord Kamall, observed, over 28% of adults are living with obesity, which puts them at risk of a whole range of health conditions. Obesity is also estimated to cost the NHS more than £11 billion per year, with total costs to the UK of £74 billion per year. The noble Baroness, Lady Jenkin, rightly referred to children’s obesity. It is shocking to realise that children with obesity are five times more likely to be living with obesity as adults. In other words, the seeds sown at the beginning are reaped in a none-too-positive way later on down the line. As mentioned by a number of noble Lords, obesity is particularly concentrated in the most deprived areas, with prevalence for children in the most deprived areas being more than double that in the least deprived areas. That gives some idea of what we are up against. As the noble Lord, Lord Krebs, and other noble Lords indicated, it is absolutely clear that we have to take action.

I share the view expressed that the challenge before us is complex. It would be wrong to see it any other way. Indeed, I share the view that obesity is primarily caused by the consumption of excess calories. We have a food environment where unhealthy foods have become cheaper and more readily available. The noble Lord, Lord Krebs, made a point about a local fitness centre display in his own area. I certainly echo his sentiment that this is not an appropriate way to assist people’s fitness. If the noble Lord has not already, I encourage him to complain to his local authority, because we need a cultural shift as well as a number of practical shifts.

In addition to the food environment that we are in, portion sizes have increased. The noble Lord, Lord McColl, rightly shines a light on this, and we are committed to addressing it. We have made a good start, and our mindset is very much about prevention over cure.

On the question from the noble Lord, Lord Krebs, we have committed to implementing junk food advertising restrictions on TV and online and to limiting schoolchildren’s access to fast food. Our 10-year health plan will also reform the NHS by shifting the focus from sickness to prevention, as noble Lords have already observed.

On the point raised by my noble friend Lord Brooke, as announced by the Chancellor yesterday we will take steps to ensure that the soft drinks industry levy remains effective and fit for purpose. That will be done by ensuring that the levy is uprated to reflect inflation since it came into force and in the future. Importantly for me, the Government will also review the soft drinks industry levy’s operation and structures, to aim to further drive down the sugar content in soft drinks. We will also review the sugar thresholds at which it applies and the exemption for milk-based drinks. I will be pleased to keep noble Lords informed on this development.

I heard the observation by the noble Lord, Lord McColl, that he considers that there is—if I may use this term—a demonisation of fats. I assure him that the dietary recommendations are about promoting a balanced diet. The advice given tells people not to avoid fat per se but—the noble Lord, Lord Krebs, referred to this—to eat foods containing saturated fats less often and in smaller quantities, and to swap to unsaturated fats where possible. The reason for this focus is that there is robust evidence that switching saturated fat for unsaturated fat lowers blood cholesterol and reduces the risk of heart disease by almost a fifth. With more than 150,000 deaths from cardiovascular disease every single year, this is crucial. Indeed, the guidance and the policies, such as junk food advertising, cover both saturated fat and sugar—something of great interest to my noble friend Lord Brooke—so it is not one thing or another, as is often the case when we are speaking about this matter.

Over 12 million people are living with obesity, so we need to provide support for them too—a number of noble Lords correctly outlined the importance of that support. The NHS and local government provide a wide range of services, including behavioural support programmes that provide advice to help people to adapt to a healthier diet.

There are more specialised services for people living with severe obesity and for associated comorbidities. These can prescribe some of the newer obesity medicines as well as offering surgery. However, I emphasise that they should be considered further down the treatment pathway. Exactly what is appropriate for any individual is down to clinicians to advise, in discussion with that patient, and to consider clinical guidance.

The noble Lord, Lord McColl, referred to Ozempic. As he will be aware, it is licensed to treat type 2 diabetes, and healthcare professionals have been reminded in guidance that it should not be prescribed solely for weight loss, although the obesity medicine Wegovy is approved for weight management on the NHS. However, obesity medicines are not a first-line treatment. Other things need to be tried first and other support needs to be in place.

I agree that the primary focus should be on supporting behavioural change, including a healthier diet, and that is confirmed through NICE guidance, but we should acknowledge that obesity medicines can be very effective at helping some people to lose considerable amounts of weight, as my noble friend Lord Mitchell and the noble Lord, Lord Rennard, have described and demonstrated. The losses are considerable—in some cases, over 20% of body weight—and that is a benefit to health.

However, as I said, these medicines should not be given alone, and support on diet and increasing physical activity, which the noble Earl, Lord Caithness, spoke about, are crucial. We need the food environment to be supportive for those managing their weight, ensuring that it is easier for people to eat more fibre, more vegetables and less sugar and salt, and to swap saturated fat for unsaturated.

I turn to the reference to “jabs for jobs”. I am grateful that noble Lords have raised this issue today, because it is an opportunity to address the media coverage. The suggestion is that the Government will somehow target people who are unemployed with such medicines to help them to get back to work. I want to be clear: the NHS continues and will continue to treat people on clinical need. We are not targeting those who are unemployed. The coverage in the media refers to a study funded by the manufacturer of one of these obesity medicines. It will build evidence to increase our understanding about the potential wider value of such medicines, and it will look at the impact on health and healthcare use and collect data on things such as change in employment status.

I turn to some of the other points raised. In answer to my noble friend Lord Brooke, we are indeed looking at incentives for reformulation and considering the balance of mandatory and voluntary measures.

I thank the noble Earl, Lord Caithness, and the noble Baroness, Lady Jenkins, for raising the work of the House of Lords committee. I am glad to see that it has recently published its final report, and I look forward to looking at it and considering the recommendations.

There are a number of specific questions that I have not been able to address, and I will be very pleased to pick up specifics in that regard.

To conclude, obesity medicines are not to be seen as the first thing to turn to—the guidance is clear on that—but they have a place for some people when other options have not worked. We and the NHS are looking at how best to make the medicines that we are considering today available in a safe and effective way.

Hospices: Funding

Baroness Merron Excerpts

Thursday 24th October 2024 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am grateful for the thoughtful and constructive approach that noble Lords have taken to this important issue and for a number of considered proposals, which I will share with my colleague, Minister Stephen Kinnock, who is responsible as the Minister for Care. I know he will be interested.

I congratulate the noble Lord, Lord Farmer, not just on securing this debate but on the way he set out his thoughts, which enabled the debate to be so constructive and sensitive to the issues at hand. I share the thanks given by a number of noble Lords, and take this opportunity to thank all those working or volunteering—as my noble friend Lady Pitkeathley highlighted—in the palliative and end-of-life care sector, including in hospices, for the invaluable support, care and compassion that they provide to people and their loved ones when they need it most.

Like the noble Earl, Lord Effingham, and other noble Lords, I pay tribute to the contribution of Dame Cicely Saunders. She was indeed—and can be regarded very much as—a pioneer. Many people in this Chamber and outside have also played their part, and I thank them too.

Approximately 600,000 people die each year in the UK and that figure is set to increase as we have an ever-ageing population. That will mean an increase in the number of people who need palliative and end-of-life care. As we have heard today, palliative care can help in the hardest of times. It is care that makes a real difference. It can make something that seems quite unbearable a bit more bearable. It can give dignity. I was very interested to hear the noble Lord, Lord Farmer, state his definition of dignity. For me, dignity is crucial at all times and never more so than at the end of one’s life. It also makes it more manageable for not just the person being cared for but their loved ones too.

As a Government, we want a society where every person receives high-quality, compassionate care, from diagnosis through to the end of life. While the majority of palliative and end-of-life care is provided by NHS staff and services, we recognise the vital part played by voluntary sector organisations. Many noble Lords know that it is difficult to quantify how much palliative and end-of-life care is being provided at national or local integrated care board level, because care is provided across multiple settings, including in primary care, community care and hospitals, as well as in hospices. It is delivered by a wide range of specialist and generalist health and care workers, who provide care for a wide range of needs. These include, but are not always exclusive to, palliative care.

I recognise that there are more than 200 charitable hospices supporting more than 300,000 people in the UK with life-limiting conditions every year. As noble Lords have observed, most hospices are charitable, independent organisations that receive some statutory funding for providing NHS services. On the point about funding, in England integrated care boards are responsible for commissioning palliative and end-of-life care services to meet the reasonable needs of their local populations. On the point raised by the noble Lord, Lord Farmer, and other noble Lords, ICBs are responsible to NHS England, which has published statutory guidance on palliative and end-of-life care to support commissioners with this duty. It includes specific reference to ensuring that there is sufficient provision of specialist palliative care services and hospice beds, and future sustainability.

The noble and right reverend Lord, Lord Sentamu, the right reverend Prelate the Bishop of London and the noble Lord, Lord Farmer, raised the issue of variation by ICB area. It is important to note that this is in part—I emphasise “in part”—dependent on what is already available in terms of services, along with local needs. Noble Lords will recall the Health and Care Act 2022, which was a key moment. I remember the noble Baroness, Lady Finlay, being very involved in getting palliative care services added to the list of services an ICB must commission in response to the needs of its local population.

In addition to the guidance and service specifications, NHS England has commissioned the development of a care dashboard. The relevance of that is that it brings together all the relevant local data into one place and it will help commissioners to understand the needs of their local population and give them the ability to filter the available information—for example, by deprivation or ethnicity. That is meant to enable ICBs to put plans in place to track and address the improvement in health inequalities.

I will refer to the highly sensitive area of assisted dying, which was raised by the noble Lords, Lord Farmer and Lord McColl, and other noble Lords. I reconfirm to your Lordships’ House that, if the will of Parliament is that the law on assisting dying should change, this Government will work to ensure that it is implemented in the way that Parliament intended and is legally effective. I add that, irrespective of whether the law changes on this matter, we will and must continue to work towards providing high-quality, compassionate palliative and end-of-life care for every person who needs it.

I shall briefly look to the future and say to my noble friend Lady Pitkeathley, who raised the matter of research, that through the National Institute for Health and Care Research the department is investing £3 million in a new policy research unit in palliative and end-of-life care. The unit was launched at the beginning of this year and it will build evidence in this area. To respond to the right reverend Prelate the Bishop of London, it will have a specific focus on inequalities, which I very much welcome.

Noble Lords will be aware that this Government have committed to developing a 10-year plan to deliver an NHS that is fit for the future. We will be considering a whole range of policies, including those that impact people with palliative and end-of-life care needs. I say to the noble Lord, Lord Howard, that one of the three shifts that the plan will deliver is around the Government’s determination to shift more healthcare out of hospitals and into the community. The noble Lord referred to a plan by Hospice UK and said it was looking to update it. We will certainly be pleased to hear from Hospice UK on that matter. Palliative and end-of-life care services, including hospices, will play a very big part in that shift from hospitals to the community.

I turn to some of the additional points that noble Lords have made. I say to the noble Baroness, Lady Finlay, who has made such a big contribution in this area, and the noble Lord, Lord Balfe, who has been a strong advocate, particularly in respect of children’s hospices, that we will indeed be delighted to look at the Welsh experience. Just this week I had a meeting with the Welsh Minister, so I will be following up on that.

The noble Lord, Lord Farmer, asked whether there will be a move to implement the recommendations in the APPG report that would ensure that funding flows to hospices. As I have said, we are determined to move more towards community healthcare and we will certainly work with hospice providers to understand their views as part of this work.

I am sure that we were all very moved to hear my noble friend Lord Monks share his experience of the sad loss of his son Daniel; my sincere condolences to my noble friend and to his family and friends. I heard what he and so many other noble Lords had to say about the quality of care received in hospices, and I too will pay tribute.

I will of course take up the points made by the noble Baroness, Lady Berridge, on gift aid with my colleagues in the Treasury.

I say to the noble Lord, Lord Balfe, and to other noble Lords that my colleague the Minister of State for Care has recently had meetings with NHS England to look at a way forward in the whole area of providing services. I know that he also met the noble Lord, Lord Balfe. We are particularly anxious to reduce inequalities and the work going forward will look at that.

I will review the debate and if there are particular questions that I have not answered, I will of course do so. I will also address the comments and suggestions made by the noble Lord, Lord Scriven. I thank all noble Lords, and particularly the noble Lord, Lord Farmer, for leading us in this debate.